II. Precautions: Pharmacogenetics

  1. See Pharmacogenetics
  2. Poor metabolizers (2-15%, 20% in asians)
    1. Clopidogrel with reduced conversion to active form (higher risk for stent closure)
    2. Amitriptyline and Nortriptyline risk of toxicity (reduce starting dose by 50%)
    3. Citalopram, Escitalopram, Sertraline risk of toxicity (reduce starting dose by 50%)
    4. Omeprazole blood concentrations are 5x higher (increased efficacy)
  3. Ultra-Metabolizers (18% of Swedes and 18% of Ethiopians)
    1. Citalopram, Escitalopram, Sertraline with reduced effect (consider alternative agents)
    2. Omeprazole blood concentrations are 40% lower
  4. Reference
    1. Sim (2006) Clin Pharmacol Ther 79:103-13 [PubMed]

III. Interactions: Metabolized by CYP2C19 (Substrates)

  1. Neuropsychiatric drugs
    1. Clomipramine
    2. Imipramine
    3. Hexobarbital
    4. Mephobarbital
    5. Diazepam
    6. Phenobarbital
    7. Phenytoin
  2. Cardiopulmonary Drugs
    1. Propranolol (Inderal)
  3. Antibiotics
    1. Nelfinavir
  4. Miscellaneous
    1. Lansoprazole
    2. Pentamidine
    3. Felbamate
    4. Omeprazole (Prilosec)

IV. Interactions: Inhibitor of CYP2C19

  1. Neuropsychiatric drugs
    1. Fluvoxamine (Luvox)
  2. Antibiotics
    1. Isoniazid (INH)
    2. Ritonavir
  3. Miscellaneous
    1. Omeprazole (Prilosec)
    2. Cimetidine

V. Interactions: Inducer of CYP2C19

  1. Neuropsychiatric Drugs
    1. Carbamazepine
    2. Phenytoin
  2. Antibiotics
    1. Rifampin

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Related Studies

Ontology: CYP2C19 protein, human (C0960580)

Definition (NCI) Cytochrome P450 2C19 (490 aa, ~56 kDa) is encoded by the human CYP2C19 gene. This protein is involved in steroid, terpenoid and drug metabolism.
Concepts Amino Acid, Peptide, or Protein (T116) , Enzyme (T126)
MSH C045793
SnomedCT 423556000
English cytochrome P450 CYP2C(mp), cytochrome P450 2C19, human, Cytochrome p450 CYP2C19 enzyme (substance), Cytochrome p450 CYP2C19 enzyme, CYP2C19, cyp2c19, Mephenytoin 4-Hydroxylase, Cytochrome P450-11A, (S)- Limonene 6-Monooxygenase, EC, EC, (S)- Limonene 7-Monooxygenase, EC 1.14.13.-, (R)- Limonene 6-Monooxygenase, Cytochrome P450-254C, EC, Cytochrome P450 2C19, Cytochrome P450, Family 2, Subfamily C, Polypeptide 19, cytochrome P450 CYP2C19 (human), CYP2C(mp) protein, human, CYP2C19, human, CYPIIC19, human, P4502C19, human, cytochrome p-450 mephenytoin 4-hydroxylase, human, mephenytoin hydroxylase, human, propranolol 4-hydroxylase, human, (S)-mephenytoin-4'-hydroxylase, human, CYP2C19 protein, human, Flavoprotein-Linked Monooxygenase, CYPIIC17, CYPIIC19, P450-11A, P450-254C, Cytochrome P450, Subfamily IIC (Mephenytoin 4-Hydroxylase), Polypeptide 19, Mephenytoin 4'-Hydroxylase, Mephenytoin 4-Prime-Hydroxylase, Microsomal Monooxygenase, Xenobiotic Monooxygenase
Spanish enzima CYP2C19 del citocromo p450, enzima CYP2C19 del citocromo p450 (sustancia), CYP2C19